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Ambrogi MC, Aprile V, Sanna S, Forti Parri SN, Rizzardi G, Fanucchi O, Valentini L, Italiani A, Morganti R, Cartia CF, Hughes JM, Lucchi M, Droghetti A. Lung Metastasectomy: Where Do We Stand? Results from an Italian Multicentric Prospective Database. J Clin Med 2024; 13:3106. [PMID: 38892816 PMCID: PMC11172471 DOI: 10.3390/jcm13113106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: The surgical resection of pulmonary metastases is considered a therapeutic option in selected cases. In light of this, we present the results from a national multicenter prospective registry of lung metastasectomy. Methods: This retrospective analysis involves data collected prospectively and consecutively in a national multicentric Italian database, including patients who underwent lung metastasectomy. The primary endpoints were the analysis of morbidity and overall survival (OS), with secondary endpoints focusing on the analysis of potential risk factors affecting both morbidity and OS. Results: A total 470 lung procedures were performed (4 pneumonectomies, 46 lobectomies/bilobectomies, 13 segmentectomies and 407 wedge resections) on 461 patients (258 men and 203 women, mean age of 63.1 years). The majority of patients had metastases from colorectal cancer (45.8%). In most cases (63.6%), patients had only one lung metastasis. A minimally invasive approach was chosen in 143 cases (30.4%). The mean operative time was 118 min, with no reported deaths. Morbidity most frequently consisted of prolonged air leaking and bleeding, but no re-intervention was required. Statistical analysis revealed that morbidity was significantly affected by operative time and pulmonary comorbidities, while OS was significantly affected by disease-free interval (DFI) > 24 months (p = 0.005), epithelial histology (p = 0.001) and colorectal histology (p = 0.004) during univariate analysis. No significant correlation was found between OS and age, gender, surgical approach, surgical extent, surgical device, the number of resected metastases, lesion diameter, the site of lesions and nodal involvement. Multivariate analysis of OS confirmed that only epithelial histology and DFI were risk-factors, with p-values of 0.041 and 0.031, respectively. Conclusions: Lung metastasectomy appears to be a safe procedure, with acceptable morbidity, even with a minimally invasive approach. However, it remains a local treatment of a systemic disease. Therefore, careful attention should be paid to selecting patients who could truly benefit from surgical intervention.
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Affiliation(s)
- Marcello Carlo Ambrogi
- Department for Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy
- Division of Thoracic Surgery, University Hospital of Pisa, 56124 Pisa, Italy
| | - Vittorio Aprile
- Department for Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy
- Division of Thoracic Surgery, University Hospital of Pisa, 56124 Pisa, Italy
| | - Stefano Sanna
- Multispecialistic Surgical Department, Private Forlì Hospitals, 47122 Forlì, Italy
| | | | - Giovanna Rizzardi
- Division of Thoracic Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy
| | - Olivia Fanucchi
- Division of Thoracic Surgery, University Hospital of Pisa, 56124 Pisa, Italy
| | - Leonardo Valentini
- Department of Thoracic Surgery, IRCCS University Hospital of Bologna, 40138 Bologna, Italy
| | - Alberto Italiani
- Division of Thoracic Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy
| | - Riccardo Morganti
- Statistical Support Division for Clinical Studies, University Hospital of Pisa, 56124 Pisa, Italy
| | | | - James M. Hughes
- Division of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
| | - Marco Lucchi
- Department for Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, 56124 Pisa, Italy
- Division of Thoracic Surgery, University Hospital of Pisa, 56124 Pisa, Italy
| | - Andrea Droghetti
- Division of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
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Li Y, Tao T, Liu Y. Development and validation of comprehensive nomograms from the SEER database for predicting early mortality in metastatic rectal cancer patients. BMC Gastroenterol 2024; 24:89. [PMID: 38408896 PMCID: PMC10898032 DOI: 10.1186/s12876-024-03178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Metastatic rectal cancer is an incurable malignancy, which is prone to early mortality. We aimed to establish nomograms for predicting the risk of early mortality in patients with metastatic rectal cancer. METHODS In this study, clinical data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database.We utilized X-tile software to determine the optimal cut-off points of age and tumor size in diagnosis. Significant independent risk factors for all-cause and cancer-specific early mortality were determined by the univariate and multivariate logistic regression analyses, then we construct two practical nomograms. In order to assess the predictive performance of nomograms, we performed calibration plots, time-dependent receiver-operating characteristic curve (ROC), decision curve analysis (DCA) and clinical impact curve (CIC). RESULTS A total of 2570 metastatic rectal cancer patients were included in the study. Multivariate logistic regression analyses revealed that age at diagnosis, CEA level, tumor size, surgical intervention, chemotherapy, radiotherapy, and metastases to bone, brain, liver, and lung were independently associated with early mortality of metastatic rectal cancer patients in the training cohort. The area under the curve (AUC) values of nomograms for all-cause and cancer-specific early mortality were all higher than 0.700. Calibration curves indicated that the nomograms accurately predicted early mortality and exhibited excellent discrimination. DCA and CIC showed moderately positive net benefits. CONCLUSIONS This study successfully generated applicable nomograms that predicted the high-risk early mortality of metastatic rectal cancer patients, which can assist clinicians in tailoring more effective treatment regimens.
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Affiliation(s)
- Yanli Li
- Department of Pharmacy, The First People's Hospital of Lianyungang, Affiliated Hospital of Xuzhou Medical University, 222061, Lianyungang, China
| | - Ting Tao
- Department of Pharmacy, The First People's Hospital of Lianyungang, Affiliated Hospital of Xuzhou Medical University, 222061, Lianyungang, China
| | - Yun Liu
- Department of Pharmacy, The First People's Hospital of Lianyungang, Affiliated Hospital of Xuzhou Medical University, 222061, Lianyungang, China.
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Lin WC, Chen PJ, Yim S, Wang HH, Liao PA, Tai CY, Yen MH. The safety and response of CT guided percutaneous cryoablation for lung nodules by 17-gauge needles. BMC Med Imaging 2023; 23:151. [PMID: 37814246 PMCID: PMC10561456 DOI: 10.1186/s12880-023-01110-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The safety and efficacy of 17-gauge needles used in CT-guided percutaneous cryoablation for lung nodules were explored in this study. The purpose of the study was to compare the findings with earlier research and multi-center clinical trials that used various needle sizes. METHODS Between 2016 and 2020, a retrospective study was conducted with approval from the institutional review board. A total of 41 patients were enrolled, and 71 lung nodules were treated in 63 cryoablation procedures using local anesthesia. Complication rates were recorded, and overall survival rates as well as tumor progression-free rates were calculated using the Kaplan-Meier method. RESULTS Self-limited hemoptysis was caused by 12.9% of the procedures, and drainage was required for pneumothoraces resulting from 11.3% of them. The overall survival rates at one, two, three, and four years were 97%, 94%, 82%, and 67%, respectively. The tumor progression-free rates at one, two, three, and four years were 86.2%, 77%, 74%, and 65%, respectively. CONCLUSION Cryoablation for lung nodules using 17-Gauge needles can achieve similar rates of survival and tumor control rates, similar or even lower complication rates as compared with other studies and multi-center trials using mixed sized needles.
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Affiliation(s)
- Wei-Chan Lin
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan.
- Department of Radiology, Cathay General Hospital, No.280 Sec 4 Ren-Ai Rd, Taipei, 10630, Taiwan.
| | - Po-Ju Chen
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Chest Surgery, Cathay General Hospital, Taipei City, 10630, Taiwan
| | - Shelly Yim
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Chest Surgery, Cathay General Hospital, Taipei City, 10630, Taiwan
| | - Hsueh-Han Wang
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Radiology, Cathay General Hospital, No.280 Sec 4 Ren-Ai Rd, Taipei, 10630, Taiwan
| | - Pen-An Liao
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Radiology, Cathay General Hospital, No.280 Sec 4 Ren-Ai Rd, Taipei, 10630, Taiwan
| | - Chia-Yu Tai
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Radiology, Cathay General Hospital, No.280 Sec 4 Ren-Ai Rd, Taipei, 10630, Taiwan
| | - Ming-Hong Yen
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Chest Surgery, Cathay General Hospital, Taipei City, 10630, Taiwan
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Ziranu P, Ferrari PA, Guerrera F, Bertoglio P, Tamburrini A, Pretta A, Lyberis P, Grimaldi G, Lai E, Santoru M, Bardanzellu F, Riva L, Balconi F, Della Beffa E, Dubois M, Pinna-Susnik M, Donisi C, Capozzi E, Pusceddu V, Murenu A, Puzzoni M, Mathieu F, Sarais S, Alzetani A, Luzzi L, Solli P, Paladini P, Ruffini E, Cherchi R, Scartozzi M. Clinical score for colorectal cancer patients with lung-limited metastases undergoing surgical resection: Meta-Lung Score. Lung Cancer 2023; 184:107342. [PMID: 37573705 DOI: 10.1016/j.lungcan.2023.107342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Radical resection of isolated lung metastases (LM) from colorectal cancer (CRC) is debated. Like Fong's criteria in liver metastases, our study was meant to assign a clinical prognostic score in patients with LM from CRC, aiming for better surgery selection. METHODS We retrospectively analyzed data from 260 CRC patients who underwent curative LM resection from December 2002 to January 2022, verifying the impact of different clinicopathological features on the overall survival (OS). RESULTS At the univariate analysis: higher baseline CEA levels (p = 0.0001), disease-free survival less than or equal to 12 months (m) (p = 0.0043), LM size larger than 2 cm (p = 0.0187), multiple resectable nodules (p = 0.0083), and positive nodal status of the primary tumor (p = 0.0011) were associated with worse prognosis. In a Cox regression model, these characteristics retained their independent role for OS (p < 0.0001) and were chosen as criteria to be assigned one point each for clinical risk score. The 5-year survival rate in patients with 0 points was 88%, while no patients with a 5-point score survived at 2 years. Based on the 0-1 vs. 2-5 score range, we obtained a significant difference in median OS: not reached vs. 40.8 months (95 %CI 36 to 87.5), respectively (p < 0.0001) stratifying patients into good and poor prognosis. The prognostic role of the score was also confirmed in terms of median RFS: not reached in 0-1 scored patients vs. 30.5 months (95 %CI 19.4 to 42) in patients with 2-5 scores (p = 0.0006). CONCLUSIONS When LM from CRC is resectable, the Meta-Lung Score provides valuable prognostic information. Indeed, while upfront surgery should be considered in patients with scores of 0 to 1, it should be cautiously suggested in patients with scores of 2 to 5, for whom a prognosis comparison between preventive surgery and other treatments should be investigated in prospective randomized clinical trials.
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Affiliation(s)
- Pina Ziranu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Paolo Albino Ferrari
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy.
| | - Francesco Guerrera
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pietro Bertoglio
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Tamburrini
- Department of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Andrea Pretta
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Paraskevas Lyberis
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giulia Grimaldi
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Eleonora Lai
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Massimiliano Santoru
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Fabio Bardanzellu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Laura Riva
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Francesca Balconi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Eleonora Della Beffa
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Marco Dubois
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Matteo Pinna-Susnik
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Clelia Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Enrico Capozzi
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Valeria Pusceddu
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Alessandro Murenu
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Marco Puzzoni
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - Federico Mathieu
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Sabrina Sarais
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Aiman Alzetani
- Department of Thoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Luca Luzzi
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Piergiorgio Solli
- Department of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Piero Paladini
- Thoracic Surgery Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena, Italy
| | - Enrico Ruffini
- Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberto Cherchi
- Division of Thoracic Surgery at "A. Businco Cancer Center", A.R.N.A.S. Brotzu, Cagliari, Italy
| | - Mario Scartozzi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
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Wlodarczyk JR, Lee SW. New Frontiers in Management of Early and Advanced Rectal Cancer. Cancers (Basel) 2022; 14:938. [PMID: 35205685 PMCID: PMC8870151 DOI: 10.3390/cancers14040938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/29/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
It is important to understand advances in treatment options for rectal cancer. We attempt to highlight advances in rectal cancer treatment in the form of a systematic review. Early-stage rectal cancer focuses on minimally invasive endoluminal surgery, with importance placed on patient selection as the driving factor for improved outcomes. To achieve a complete pathologic response, various neoadjuvant chemoradiation regimens have been employed. Short-course radiation therapy, total neoadjuvant chemotherapy, and others provide unique advantages with select patient populations best suited for each. With a clinical complete response, a "watch and wait" non-operative surveillance has been introduced with preliminary equivalency to radical resection. Various modalities for total mesorectal excision, such as robotic or transanal, have advantages and can be utilized in select patient populations. Tumors demonstrating solid organ or peritoneal spread, traditionally defined as unresectable lesions conveying a terminal diagnosis, have recently undergone advances in hepatic and pulmonary metastasectomy. Hepatic and pulmonary metastasectomy has demonstrated clear advantages in 5-year survival over standard chemotherapy. With the peritoneal spread of colorectal cancer, HIPEC with cytoreductive therapy has emerged as the preferred treatment. Understanding the various therapeutic interventions will pave the way for improved patient outcomes.
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Affiliation(s)
| | - Sang W. Lee
- Division of Colorectal Surgery, Norris Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite NTT-7418, Los Angeles, CA 90033, USA;
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Lee KY, Lau J, Siew BE, Chua YK, Lim YX, Lim XY, Chong CS, Tan KK. Does pulmonary metastasectomy of colorectal metastases translate to
better survival? A systematic review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2021255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACT
Introduction: Surgical resection of the primary and metastatic tumour is increasingly recommended
in suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is well
studied and established in colorectal liver metastasis, evidence remains limited in pulmonary metastases.
This systematic review was conducted to examine the current evidence on the role of lung metastasectomy
(LUM) in CRC.
Methods: Three databases were systematically searched, to identify studies that compared survival
outcomes of LUM, and factors that affected decision for LUM.
Results: From a total of 5,477 records, 6 studies were eventually identified. Two papers reported
findings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survival
benefit in patients who underwent LUM compared to those who did not. When compared against patients
who underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwent
LUM were also more likely to have a single pulmonary tumour, and metachronous disease.
Conclusion: The evidence suggests a role for LUM, but is limited by inherent selection bias in retrospective
reviews, and the single randomised clinical trial performed was not completed. More prospective studies
are required to understand the true effect of LUM on outcomes in metastatic CRC.
Keywords: Colorectal cancer, pulmonary metastasectomy, pulmonary metastases, survival
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Affiliation(s)
- Kai-Yin Lee
- National University Health System, Singapore
| | | | | | | | | | - Xin-Yi Lim
- National University of Singapore, Singapore
| | | | - Ker-Kan Tan
- National University Health System, Singapore
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Girard P, Gossot D, Mariolo A, Caliandro R, Seguin-Givelet A, Girard N. Oligometastases for Clinicians: Size Matters. J Clin Oncol 2021; 39:2643-2646. [PMID: 34133197 DOI: 10.1200/jco.21.00445] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Effectiveness of intraoperative bimanual palpation in metastatic tumors of lung. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:662-668. [PMID: 33403140 PMCID: PMC7759051 DOI: 10.5606/tgkdc.dergisi.2020.20429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/01/2020] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to compare effectiveness of thoracic computed tomography versus intraoperative bimanual palpation in the detection of number of nodules in patients undergoing thoracotomy. Methods Between January 2011 and January 2019, a total of 157 patients (63 males, 94 females; mean age: 46.6±11.2 years; range, 13 to 77 years) who underwent pulmonary metastasectomy in our institution were retrospectively analyzed. Metastatic nodules evaluated using thoracic computed tomography were compared with nodules detected by intraoperative palpation. Results A total of 226 muscle-sparing thoracotomy was performed in 157 patients. The time between the preoperative thoracic computed tomography and operation ranged from 3 to 24 days. Metastasectomy with muscle-sparing thoracotomy was performed in 41 (26%) patients two times, in eight (5%) patients three times, and in four (2.5%) patients four times due to bilateral lung metastasis or re-metastasectomy. The thoracic computed tomography could detect 476 metastatic nodules, while 1,218 nodules were palpated and resected intraoperatively. Of these nodules, 920 were pathologically evaluated as metastatic. Conclusion Our study results showed that the number of nodules reported as pathologically malignant after resection was 1.9 times higher than those reported by thoracic computed tomography. This finding indicates that intraoperative bimanual examination significantly increases the possibility of complete resection. This situation raises the need for more caution for the thoracoscopic metastasectomy procedure in which there is no possibility of intraoperative bimanual palpation.
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Zhang L, Zhang Y, Zhu H, Sun X, Wang X, Wu P, Xu X. Overexpression of miR‐301a‐3p promotes colorectal cancer cell proliferation and metastasis by targeting deleted in liver cancer‐1 and runt‐related transcription factor 3. J Cell Biochem 2018; 120:6078-6089. [PMID: 30362160 DOI: 10.1002/jcb.27894] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/24/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Liuliu Zhang
- Department of Medical Oncology Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Yi Zhang
- Pathology Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Huayun Zhu
- Department of Medical Oncology Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Xiaofeng Sun
- Department of Medical Oncology Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Xiaohua Wang
- Department of Medical Oncology Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Pingping Wu
- Department of Medical Oncology Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
| | - Xinyu Xu
- Pathology Department Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University Nanjing China
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Kumar NAN, Verma K, Shinde RS, Kammar P, Dusane R, Desouza A, Ostwal V, Patil P, Engineer R, Karimundackal G, Pramesh CS, Saklani A. Pulmonary metastasectomy of colorectal cancer origin: Evaluating process and outcomes. J Surg Oncol 2018; 118:1292-1300. [PMID: 30332511 DOI: 10.1002/jso.25273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study was undertaken to evaluate the effect of change in policy of computed tomography (CT) scan of the thorax in staging and follow-up of colorectal cancer (CRC). Another objective was to review the outcomes following pulmonary metastasectomies (Pmets) and to determine the prognostic factors affecting outcomes. METHODS This is a retrospective analysis from a prospective cohort database of patients, who underwent Pmet for CRC origin from August 2004 to February 2016. The outcome measures were number of Pmets per year, overall survival (OS), disease-free survival (DFS), and prognostic factors affecting survival. RESULTS Of 71 patients, 38% (n = 27) underwent Pmet before 2013 and 62% ( n = 44) had surgery after 2013. The 2-year DFS after Pmet was 49.3% and estimated 5-year OS was 51.4% at a median follow-up of 28 months. There was a significant increase in number of Pmets/year ( P = 0.0015), increased detection of synchronous pulmonary metastasis (PM) ( P = 0.005), increased diagnosis of extra-pulmonary metastases (EPM) ( P = 0.005), and improved OS ( P = 0.026) after introduction of CT scan as staging tool. Site of primary tumor (colon) ( P = 0.045), primary nodal stage ( P = 0.009), and the presence of EPM ( P = 0.01) were independent important prognostic factors affecting survival. CONCLUSION The CT scan of thorax as a baseline tool for staging and follow-up in CRC increases referral for pulmonary metastasectomy. Surgery achieves excellent prognosis and long-term survival outcomes in CRC with isolated PM and carefully selected patients with solitary liver metastasis.
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Affiliation(s)
- Naveena A N Kumar
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Kamlesh Verma
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Rajesh S Shinde
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Praveen Kammar
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Rohit Dusane
- Division of Clinical Research and Statistics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ashwin Desouza
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prachi Patil
- Department of Medical Gastroenterology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - George Karimundackal
- Department of Thoracic surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Thoracic surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Avanish Saklani
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Bozzetti F, Bignami P, Baratti D. Surgical Strategies in Colorectal Cancer Metastatic to the Liver. TUMORI JOURNAL 2018; 86:1-7. [PMID: 10778758 DOI: 10.1177/030089160008600101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Surgical resection remains a milestone in the treatment of colorectal metastases to the liver. There is a distinct subset of patients who benefit from surgical resection in terms of longer survival or definitive cure. The main effort of the surgical oncological regards the safety of the procedure and the adequacy of the recommendation. Many studies, some of them including multivariate analysis, have shown the presence of prognostic determinants of long-term survival and prognostic indexes of the outcome after hepatectomy. It is now accepted that liver resection should be done when the complete excision of all demonstrable tumor with clear resection margins is feasible. Major contra-indication is represented by the presence of extra-hepatic intra-abdominal disease or of unresectable lung metastatic deposits. There is a wide literature indicating that in very selected patients liver reresection and multiorgan synchronous or metachronous resections are beneficial. The role of neoadjuvant chemotherapy and especially postoperative adjuvant local (intra-hepatic) and systemic chemotherapy is promising and supported by recent multicenter randomised clinical trials.
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Affiliation(s)
- F Bozzetti
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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Wang S, Huang Y, Mu X, Qi T, Qiao S, Lu Z, Li H. DNA methylation is a common molecular alteration in colorectal cancer cells and culture method has no influence on DNA methylation. Exp Ther Med 2018; 15:3173-3180. [PMID: 29545832 PMCID: PMC5841015 DOI: 10.3892/etm.2018.5809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 04/21/2017] [Indexed: 12/15/2022] Open
Abstract
The present study aimed to explore whether culture method had an influence on DNA methylation in colorectal cancer (CRC). In the present study, CRC cells were cultured in two-dimensional (2D), three-dimensional (3D) and mouse orthotopic transplantation (Tis) cultures. Principal component analysis (PCA) was used for global visualization of the three samples. A Venn diagram was applied for intersection and union analysis for different comparisons. The methylation condition of 5′-C-phosphate-G-3′ (CpG) location was determined using unsupervised clustering analysis. Scatter plots and histograms of the mean β values between 3D vs. 2D, 3D vs. Tis and Tis vs. 2D were constructed. In order to explore the biological function of the genes, gene ontology and Kyoto Encyclopedia of Gene and Genomes (KEGG) pathway analyses were utilized. To explore the influence of culture condition on genes, quantitative methylation specific polymerase chain reaction (QMSP) was performed. The three samples connected with each other closely, as demonstrated by PCA. Venn diagram analysis indicated that some differential methylation positions were commonly shared in the three groups of samples and 16 CpG positions appeared hypermethylated in the three samples. The methylation patterns between the 3D and 2D cultures were more similar than those of 3D and Tis, and Tis and 2D. Results of gene ontology demonstrated that differentially expressed genes were involved in molecular function, cellular components and biological function. KEGG analysis indicated that genes were enriched in 13 pathways, of which four pathways were the most evident. These pathways were pathways in cancer, mitogen-activated protein kinase signaling, axon guidance and insulin signaling. Furthermore, QMSP demonstrated that methylation of mutL homolog, phosphatase and tensin homolog, runt-related transcription factor, Ras association family member, cadherin-1, O-6-methylguanine-DNA-methyltransferase and P16 genes had no obvious difference in 2D, 3D and Tis culture conditions. In conclusion, the culture method had no influence on DNA methylation in CRC cells.
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Affiliation(s)
- Shibao Wang
- Department of Oncology and Hematology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Yinghui Huang
- Science Research Center, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xupeng Mu
- Science Research Center, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Tianyang Qi
- Science Research Center, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Sha Qiao
- Department of Oncology and Hematology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Zhenxia Lu
- Department of Oncology and Hematology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Hongjun Li
- Physical Examination Center, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
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Prognostic Significance of Peritoneal Metastasis in Stage IV Colorectal Cancer Patients With R0 Resection: A Multicenter, Retrospective Study. Dis Colon Rectum 2017; 60:1041-1049. [PMID: 28891847 DOI: 10.1097/dcr.0000000000000858] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stage IV colorectal cancer encompasses various clinical conditions. The differences in prognosis after surgery between different metastatic organs have not been fully investigated. OBJECTIVE This study aimed to assess prognostic significance in peritoneal metastasis in R0 resected stage IV colorectal cancer. DESIGN We conducted a multicenter retrospective study of patients with R0 resected stage IV colorectal cancer; they were categorized into 3 groups according to the number and location of metastatic organs, including single-organ metastasis in the peritoneum, single-organ metastasis at sites except the peritoneum, and multiple-organ metastases. SETTINGS This study used data accumulated by the Japanese Study Group for Postoperative Follow-Up of Colorectal Cancer. PATIENTS A total of 1133 patients with R0 resected stage IV colorectal cancer were registered retrospectively between 1997 and 2007 in 20 referral hospitals. MAIN OUTCOME MEASURES Cancer-specific survival rates between the groups were measured. RESULTS The median cancer-specific survival of the single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group and was almost comparable to that of the multiple-organ metastases group (3.41 years, 6.20 years, and 2.99 years). In a multivariate analysis of cancer-specific survival, peritoneal dissemination was confirmed as an independent prognostic factor of survival. The median postrecurrence survival of single-organ metastasis in the peritoneum group was considerably shorter than that of the single-organ metastasis at a site other than the peritoneum group. Approximately half of the patients who experienced recurrence of single-organ metastasis in the peritoneum experienced peritoneal recurrence. LIMITATIONS This was a retrospective, population-based study that requires a prospective design to validate its conclusions. CONCLUSIONS Peritoneal metastasis of colorectal cancer frequently recurred in the peritoneum even after R0 resection. The cancer-specific survival of the single-organ metastasis in the peritoneum group was as poor as that of the multiple-organ metastases group. See Video Abstract at http://links.lww.com/DCR/A398.
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Patrini D, Panagiotopoulos N, Lawrence D, Scarci M. Surgical management of lung metastases. Br J Hosp Med (Lond) 2017; 78:192-198. [PMID: 28398890 DOI: 10.12968/hmed.2017.78.4.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Management of pulmonary metastases has evolved considerably over the last few decades but is still controversial. The surgical management of lung metastases is outlined, discussing the preoperative management, indications for surgery, the surgical approach and outcomes according to the primary histology.
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Affiliation(s)
- Davide Patrini
- Senior Registrar in Thoracic Surgery, Thoracic Surgery Department, University College London Hospitals, London W1G 8PH
| | - Nikolaos Panagiotopoulos
- Consultant Thoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
| | - David Lawrence
- Consultant Cardiothoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
| | - Marco Scarci
- Consultant Thoracic Surgeon, Thoracic Surgery Department, University College London Hospitals, London
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Han YH, Lim ST, Jeong HJ, Sohn MH. Clinical Value of a One-Stop-Shop Low-Dose Lung Screening Combined with (18)F-FDG PET/CT for the Detection of Metastatic Lung Nodules from Colorectal Cancer. Nucl Med Mol Imaging 2016; 50:144-9. [PMID: 27275363 DOI: 10.1007/s13139-015-0387-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/17/2015] [Accepted: 12/01/2015] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the clinical usefulness of additional low-dose high-resolution lung computed tomography (LD-HRCT) combined with (18)F-fluoro-2-deoxyglucose positron emission tomography with CT ((18)F-FDG PET/CT) compared with conventional lung setting image of (18)F-FDG PET/CT for the detection of metastatic lung nodules from colorectal cancer. METHODS From January 2011 to September 2011, 649 patients with colorectal cancer underwent additional LD-HRCT at maximum inspiration combined with (18)F-FDG PET/CT. Forty-five patients were finally diagnosed to have lung metastasis based on histopathologic study or clinical follow-up. Twenty-five of the 45 patients had ≤5 metastatic lung nodules and the other 20 patients had >5 metastatic nodules. One hundred and twenty nodules in the 25 patients with ≤5 nodules were evaluated by conventional lung setting image of (18)F-FDG PET/CT and by additional LD-HRCT respectively. Sensitivities, specificities, diagnostic accuracies, positive predictive values (PPVs), and negative predictive values (NPVs) of conventional lung setting image of (18)F-FDG PET/CT and additional LD-HRCT were calculated using standard formulae. The McNemar test and receiver-operating characteristic (ROC) analysis were performed. RESULTS Of the 120 nodules in the 25 patients with ≤5 metastatic lung nodules, 66 nodules were diagnosed as metastatic. Eleven of the 66 nodules were confirmed histopathologically and the others were diagnosed by clinical follow-up. Conventional lung setting image of (18)F-FDG PET/CT detected 40 of the 66 nodules and additional LD-HRCT detected 55 nodules. All 15 nodules missed by conventional lung setting imaging but detected by additional LD-HRCT were <1 cm in size. The sensitivity, specificity, and diagnostic accuracy of the modalities were 60.6 %, 85.2 %, and 71.1 % for conventional lung setting image and 83.3 %, 88.9 %, and 85.8 % for additional LD-HRCT. By ROC analysis, the area under the ROC curve (AUC) of conventional lung setting image and additional LD-HRCT were 0.712 and 0.827 respectively. CONCLUSION Additional LD-HRCT with maximum inspiration was superior to conventional lung setting image of (18)F-FDG PET/CT for the detection of metastatic lung nodules from colorectal cancer (P < 0.05).
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Affiliation(s)
- Yeon-Hee Han
- Department of Nuclear Medicine, Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk Republic of Korea
| | - Seok Tae Lim
- Department of Nuclear Medicine, Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk Republic of Korea
| | - Hwan-Jeong Jeong
- Department of Nuclear Medicine, Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk Republic of Korea
| | - Myung-Hee Sohn
- Department of Nuclear Medicine, Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Cyclotron Research Center, Molecular Imaging and Therapeutic Medicine Research Center, Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk Republic of Korea
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Ihn MH, Kim DW, Cho S, Oh HK, Jheon S, Kim K, Shin E, Lee HS, Chung JH, Kang SB. Curative Resection for Metachronous Pulmonary Metastases from Colorectal Cancer: Analysis of Survival Rates and Prognostic Factors. Cancer Res Treat 2016; 49:104-115. [PMID: 27188203 PMCID: PMC5266407 DOI: 10.4143/crt.2015.367] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 04/18/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose Prognostic factors in patients with pulmonary metastases (PM) from colorectal cancer (CRC) are still controversial. This study assessed oncologic outcomes and prognostic factors in patients with metachronous PM from CRC. Materials and Methods Between June 2003 and December 2011, 122 patients with CRC underwent curative resection of PM detected at least 4 months after CRC resection. Clinico-pathological factors selected from the prospectively maintained database were analyzed retrospectively. Results The median disease-free interval (DFI) between resection of the primary tumor and detection of PM was 22.0 months (range, 4 to 85 months). Solitary PM were detected in 77 patients (63.1%), with a median maximal tumor diameter of 12.0 mm (range, 2 to 70 mm). Of 52 patients who underwent mediastinal lymph node (LN) dissection, eight patients had LN involvement. Five-year overall survival and disease-free survival (DFS) rates after initial pulmonary metastasectomy were 66.4% and 50.9%, respectively. DFI, mediastinal LN involvement, and the number and distribution of PM were significantly prognostic factors for DFS. In multivariable analysis DFI ≥ 12 months, solitary lesion, and absence of mediastinal LN involvement were independently prognostic for DFS. Of the 122 patients, 48 patients (39.3%) developed recurrent PM a median 13.0 months after initial pulmonary metastasectomy. Recurrent DFI was independently prognostic of DFS in patients who underwent repeated pulmonary metastasectomy. Conclusion There is a potential survival benefit for patients with metachronous PM from CRC who undergo pulmonary metastasectomy, even those with recurrent PM. Pulmonary metastasectomy should be considered in selected patients, particularly those with longer DFI, solitary lesions, and absence of mediastinal LN involvement.
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Affiliation(s)
- Myong Hoon Ihn
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun Shin
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Management of resectable colorectal lung metastases. Clin Exp Metastasis 2015; 33:285-96. [DOI: 10.1007/s10585-015-9774-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/07/2015] [Indexed: 02/07/2023]
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Subbiah IM, Blackmon SH, Correa AM, Kee B, Vaporciyan AA, Swisher SG, Eng C. Preoperative chemotherapy prior to pulmonary metastasectomy in surgically resected primary colorectal carcinoma. Oncotarget 2015; 5:6584-93. [PMID: 25051371 PMCID: PMC4196147 DOI: 10.18632/oncotarget.2172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The benefit of preoperative chemotherapy prior to pulmonary metastasectomy for patients with colorectal carcinoma (CRC) is unknown. Here, we identify outcomes of preoperative chemotherapy in patients with resected primary CRC who then underwent pulmonary metastasectomy. METHODS We queried a prospective database to identify treatment characteristics. Multivariate analyses identified predictors of overall survival (OS) and progression-free survival (PFS). RESULTS 229 patients underwent lung metastasectomy, of whom 115 proceeded to surgery without chemotherapy while 114 received preoperative regimen based on oxaliplatin (32%), irinotecan (46%), capecitabine (16%), or other (6%). Median PFS in preoperative chemotherapy vs. surgery alone arms were comparable (p=0.004). Patients on oxaliplatin-based therapy had an improved OS vs. an irinotecan, capecitabine, or alternate regimen (p=.019). On multivariate analysis, the irinotecan subset had a worse OS (HR 1.846; 95% CI 1.070, 3.185) vs. surgery alone arm (p=0.028). The OS of an oxaliplatin-based regimen vs. no chemotherapy was inconclusive (HR 0.57; 95% CI 0.237 to 1.389, p=0.218). Multivariate analysis demonstrated a worse PFS and OS for the male gender and an incomplete resection (R2). CONCLUSION Prospective trials on specific preoperative regimens and criteria for patient selection may identify a role for preoperative chemotherapy prior to a curative pulmonary metastasectomy.
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Affiliation(s)
- Ishwaria M Subbiah
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shanda H Blackmon
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Surgery, The Methodist Hospital and Weill Cornell College of Medicine, Houston, Texas
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bryan Kee
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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KRAS and BRAF mutations are prognostic biomarkers in patients undergoing lung metastasectomy of colorectal cancer. Br J Cancer 2015; 112:720-8. [PMID: 25688918 PMCID: PMC4333487 DOI: 10.1038/bjc.2014.499] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/24/2014] [Accepted: 08/19/2014] [Indexed: 02/07/2023] Open
Abstract
Background: We evaluated KRAS (mKRAS (mutant KRAS)) and BRAF (mBRAF (mutant BRAF)) mutations to determine their prognostic potential in assessing patients with colorectal cancer (CRC) for lung metastasectomy. Methods: Data were reviewed from 180 patients with a diagnosis of CRC who underwent a lung metastasectomy between January 1998 and December 2011. Results: Molecular analysis revealed mKRAS in 93 patients (51.7%), mBRAF in 19 patients (10.6%). In univariate analyses, overall survival (OS) was influenced by thoracic nodal status (median OS: 98 months for pN−, 27 months for pN+, P<0.0001), multiple thoracic metastases (75 months vs 101 months, P=0.008) or a history of liver metastases (94 months vs 101 months, P=0.04). mBRAF had a significantly worse OS than mKRAS and wild type (WT) (P<0.0001). The 5-year OS was 0% for mBRAF, 44% for mKRAS and 100% for WT, with corresponding median OS of 15, 55 and 98 months, respectively (P<0.0001). In multivariate analysis, WT BRAF (HR: 0.005 (95% CI: 0.001–0.02), P<0.0001) and WT KRAS (HR: 0.04 (95% CI: 0.02–0.1), P<0.0001) had a significant impact on OS. Conclusions: mKRAS and mBRAF seem to be prognostic factors in patients with CRC who undergo lung metastasectomy. Further studies are necessary.
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Oh SY, Kim DY, Suh KW. Oncologic outcomes following metastasectomy in colorectal cancer patients developing distant metastases after initial treatment. Ann Surg Treat Res 2015; 88:253-9. [PMID: 25960988 PMCID: PMC4422878 DOI: 10.4174/astr.2015.88.5.253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/20/2014] [Accepted: 11/26/2014] [Indexed: 12/27/2022] Open
Abstract
Purpose We performed a comparative analysis of the clinicopathologic features and oncologic outcomes of colorectal cancer patients with metachronous versus synchronous metastasis, according to the prognostic factors. Methods Ninety-three patients who underwent curative resection for distant metastatic colorectal cancer were included in the study between December 2001 and December 2011. We assessed recurrence-free survival and overall survival in patients with distant metastasis who underwent curative surgery. Results The most common site of distant metastasis was lung alone (n = 19, 51.4%) in patients with metachronous metastasis, while liver alone was most common in those with synchronous metastasis (n = 40, 71.4%). Overall survival rate was significantly different between patients with synchronous metastasis and metachronous metastasis (34.0% vs. 53.7%; P = 0.013). Incomplete resection of the metastatic lesion was significantly related to poor overall survival in both, patients with synchronous metastasis, and metachronous metastasis. Conclusion Our study indicates that patients developing distant metastasis after initial treatment show a different metastatic pattern and better oncologic outcomes, as compared to those presenting with distant metastasis. Resection with tumor free margins significantly improves survival in patients with metachronous as well as synchronous metastasis.
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Affiliation(s)
- Seung Yeop Oh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Do Yoon Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Wook Suh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Bartlett EK, Simmons KD, Wachtel H, Roses RE, Fraker DL, Kelz RR, Karakousis GC. The rise in metastasectomy across cancer types over the past decade. Cancer 2014; 121:747-57. [PMID: 25377689 DOI: 10.1002/cncr.29134] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 09/10/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although studies of metastasectomy have been limited primarily to institutional experiences, reports of favorable long-term outcomes have generated increasing interest. In the current study, the authors attempted to define the national practice patterns in metastasectomy for 4 common malignancies with varying responsiveness to systemic therapy. METHODS The National (Nationwide) Inpatient Sample was used to estimate the national incidence of metastasectomy for colorectal cancer, lung cancer, breast cancer, and melanoma from 2000 through 2011. Incidence-adjusted rates were determined for liver, lung, brain, small bowel, and adrenal metastasectomies. The average annual percentage change (AAPC) in metastasectomy by cancer type was calculated using joinpoint regression. RESULTS Colorectal cancer was the most common indication for metastasectomy (87,407 cases; 95% confidence interval [95% CI], 86,307-88,507 cases) followed by lung cancer (58,245 cases; 95% CI, 57,453-59,036 cases), breast cancer (26,271 cases; 95% CI, 25,672-26,870 cases), and melanoma (20,298 cases; 95% CI, 19,897-20,699 cases). Metastasectomy increased significantly for all cancer types over the study period: colorectal cancer (AAPC, 6.83; 95% CI, 5.7-7.9), lung cancer (AAPC, 5.8; 95% CI, 5.1-6.4), breast cancer (AAPC, 5.5; 95% CI, 3.7-7.3), and melanoma (AAPC, 4.03; 95% CI, 2.1-6.0). Despite an increasing number of comorbidities in patients undergoing metastasectomy (P<.05 for each cancer type), inpatient mortality rates after metastasectomy fell for all cancer types, most significantly for colorectal (AAPC, -5.49; 95% CI, -8.2 to -2.7) and lung (AAPC, -6.2; 95% CI, -11.7 to -0.3) cancers. The increasing performance of metastasectomy was largely driven by high-volume institutions, in which patients had a lower mean number of comorbidities (P<.01 for all cancer types) and lower inpatient mortality (P<.01 for all cancers except melanoma). CONCLUSIONS From 2000 through 2011, the performance of metastasectomy increased substantially across common cancer types, notwithstanding various advances in systemic therapies. Metastasectomy was performed more safely, despite increasing patient comorbidity. High-volume institutions appeared to drive practice patterns.
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Affiliation(s)
- Edmund K Bartlett
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Renaud S, Falcoz PE, Olland A, Schaeffer M, Reeb J, Santelmo N, Massard G. The intrathoracic lymph node ratio seems to be a better prognostic factor than the level of lymph node involvement in lung metastasectomy of colorectal carcinoma. Interact Cardiovasc Thorac Surg 2014; 20:215-21. [DOI: 10.1093/icvts/ivu364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Meimarakis G, Spelsberg F, Angele M, Preissler G, Fertmann J, Crispin A, Reu S, Kalaitzis N, Stemmler M, Giessen C, Heinemann V, Stintzing S, Hatz R, Winter H. Resection of Pulmonary Metastases from Colon and Rectal Cancer: Factors to Predict Survival Differ Regarding to the Origin of the Primary Tumor. Ann Surg Oncol 2014; 21:2563-72. [DOI: 10.1245/s10434-014-3646-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Indexed: 12/18/2022]
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Renaud S, Alifano M, Falcoz PE, Magdeleinat P, Santelmo N, Pagès O, Massard G, Régnard JF. Does nodal status influence survival? Results of a 19-year systematic lymphadenectomy experience during lung metastasectomy of colorectal cancer. Interact Cardiovasc Thorac Surg 2014; 18:482-7. [PMID: 24442624 DOI: 10.1093/icvts/ivt554] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Resection of pulmonary metastases originating from colorectal cancer is increasingly considered. While several adverse risk factors for long-term outcome are known, the selection of patients who may benefit from surgery remains unclear. In particular, few studies have addressed the impact of lymph node involvement, and signification of the hilar or mediastinal level of extent. METHODS We retrospectively reviewed the data of 320 patients operated in two thoracic departments between 1992 and 2011. Appropriate statistical tests were used to compare groups at risk. RESULTS There were 105 women and 215 men with a mean age of 63.3 years (range: 27-86) at the time of metastasectomy. Lymph node involvement appeared as a significant prognostic factor in both the univariate and multivariate analyses [median survival: 94 months N0 vs 42 months N+, P < 0.0001; OR = 0.573 (0.329-1), P = 0.05]. Survival was similar for hilar and mediastinal locations (median survival: 47 months vs 37 months, respectively, P = 0.14). Associated hepatic metastases had a negative impact on survival in both univariate and multivariate analyses [median survival: 74 months vs 47 months, P < 0.01; OR = 0.387 (0.218-0.686), P = 0.001]. Multiple lung metastases significantly decreased survival in univariate analysis only (median survival: 81 months vs 55 months, P < 0.01). Disease-free survival and preoperative carcinoembryonic antigen had no impact on survival. CONCLUSIONS While lymph node involvement was associated with decreased survival, the impact of mediastinal location on survival did not differ from that of hilar location. Consequently, these patients should not be excluded from surgical treatment.
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Affiliation(s)
- Stéphane Renaud
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
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Analysis of treatment that includes both hepatic and pulmonary resections for colorectal metastases. Surg Today 2013; 44:702-11. [PMID: 24170275 DOI: 10.1007/s00595-013-0769-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 03/04/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Hepatic or pulmonary resections for colorectal metastases are regarded as standard treatment worldwide; however, the clinical significance of both hepatic and pulmonary resections for colorectal metastases remains undefined. We reviewed our clinical experience to evaluate the benefit of this treatment. METHODS Between 1986 and 2010, 186 patients underwent potentially curative hepatic and/or pulmonary resections for colorectal metastases. Of these patients, 25 underwent both treatments (Group C), 100 underwent hepatic resections alone (Group H), and 61 underwent pulmonary resections alone (Group L). Univariate and multivariate analyses of the clinical and pathological variables in Group C and comparative survival analyses between Group C and Groups H-L were performed. RESULTS In Group C, the median survival after primary tumor resection, initial metastasectomy, and last metastasectomy were 97, 60, and 35 months, respectively, and the 5-year overall survival rates were 63, 54, and 38%, respectively. Multivariate analyses after initial metastasectomy revealed rectal tumors, multiple hepatic tumors, and simultaneous metastases as poor prognostic factors. Comparative survival analyses revealed no significant difference in overall survival between Group C and Groups H-L. CONCLUSION Hepatic and pulmonary resections for colorectal metastases improve survival and may even offer the potential for cure in selected patients.
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Brandi G, Derenzini E, Falcone A, Masi G, Loupakis F, Pietrabissa A, Pinna AD, Ercolani G, Pantaleo MA, Di Girolamo S, Grazi GL, de Rosa F, Biasco G. Adjuvant systemic chemotherapy after putative curative resection of colorectal liver and lung metastases. Clin Colorectal Cancer 2013; 12:188-94. [PMID: 23773458 DOI: 10.1016/j.clcc.2013.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 03/06/2013] [Accepted: 04/15/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Marginal statistical evidence of efficacy of adjuvant and/or perioperative chemotherapy after resection of colorectal metastases exists, but formal recommendations are still lacking. The present study evaluated the adjuvant systemic chemotherapy after the first resection of liver and lung colorectal cancer metastases. PATIENTS AND METHODS We retrospectively reviewed data of 181 consecutive unselected patients with R0 resection of colorectal metastases treated simultaneously at 2 institutions from 1997 to 2004. Patients > 75 years old, with an Eastern Cooperative Oncology Group Performance Status Score ≥ 2 or unfit for adjuvant chemotherapy were excluded from the analysis. The decision on chemotherapy after surgery was left to the patient in the absence of conclusive data on the efficacy of adjuvant chemotherapy in this setting. A total of 151 patients (131 with liver metastases, 20 with lung metastases), 78 of whom underwent adjuvant chemotherapy, were evaluable for disease-free survival (DFS) and overall survival. The main prognostic factors for DFS after resection of colorectal cancer metastases were investigated in univariate and multivariate analyses. RESULTS At the univariate analysis, the number of resected lesions, lesion volume, disease-free interval and adjuvant systemic chemotherapy were the only significant prognostic factors. At multivariate analysis, only adjuvant chemotherapy and disease-free interval were independent prognostic factors (hazard ratios 1.66 and 1.62, respectively). The median DFS of patients who underwent systemic adjuvant chemotherapy was 16 months compared with 9.7 months for patients with observation alone (hazard ratio 1.56). Estimated 5-year DFS was 17.4% and 10.5% for treated and untreated patients, respectively. CONCLUSION Adjuvant chemotherapy after metastasectomy in patients with colorectal cancer showed a significant benefit for DFS.
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Affiliation(s)
- Giovanni Brandi
- Seràgnoli Department of Hematology and Oncological Sciences, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
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Cho S, Song IH, Yang HC, Jheon S. Prognostic factors of pulmonary metastasis from colorectal carcinoma. Interact Cardiovasc Thorac Surg 2013; 17:303-7. [PMID: 23613338 DOI: 10.1093/icvts/ivt164] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study was conducted to investigate the prognostic factors of pulmonary metastases, focusing on the time of detection of pulmonary metastases related to adjuvant chemotherapy in patients with colorectal cancer (CRC). METHODS Between June 2003 and December 2010, 84 patients underwent pulmonary metastasectomy for pulmonary metastasis (PM) from CRC. The clinicopathological data of colorectal surgery and pulmonary metastasectomy were analysed retrospectively. Disease-free intervals (DFIs) were specifically classified into the following three groups related to adjuvant chemotherapy after colorectal operation: Group 1, metastasis detected at initial presentation; Group 2, metastasis detected during adjuvant chemotherapy; Group 3, metastasis detected after completion of chemotherapy. The prognostic influence of these variables on disease-free survival was analysed using the log-rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis. RESULTS The median follow-up durations for patients after curative resection of CRC and pulmonary metastasectomy were 48.6 and 28.8 months, respectively. After pulmonary metastasectomy, recurrence was seen in 49 (58.3%) patients-pulmonary recurrence in 37 and extrathoracic recurrence in 12. Young age (<54 years old) at CRC operation, more than one PM, a DFIs of <12 months, detection synchronously or under adjuvant chemotherapy, and high CEA level before metastasectomy were worse prognostic factors by univariate analysis. From multivariate analysis, the number of pulmonary metastases (multiple metastases, HR=2.121, 95% confidence interval 1.081-4.159, P=0.029) and DFIs related with adjuvant chemotherapy (Group 1+2, HR=1.982, 95% confidence interval 1.083-3.631, P=0.027) were found to be independent predictors of disease-free survival. CONCLUSIONS Disease-free intervals in association with the time of adjuvant chemotherapy and number of metastases were independent poor prognostic factors for pulmonary metastases from colorectal cancer.
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Affiliation(s)
- Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi, Korea.
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Meimarakis G, Angele M, Conrad C, Schauer R, Weidenhagen R, Crispin A, Giessen C, Preissler G, Wiedemann M, Jauch KW, Heinemann V, Stintzing S, Hatz RA, Winter H. Combined resection of colorectal hepatic-pulmonary metastases shows improved outcome over chemotherapy alone. Langenbecks Arch Surg 2013; 398:265-76. [PMID: 23314791 DOI: 10.1007/s00423-012-1046-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 12/29/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this retrospective study was to assess the survival of patients after resection of hepatic and pulmonary colorectal metastases to identify predictors of long-term survival. METHODS Patients receiving chemotherapy alone were compared to patients receiving surgery and chemotherapy in a matched-pair analysis with the following criteria: UICC stage, grading, and date of initial primary tumor occurrence. RESULTS A total of 30 patients with liver and lung metastases of colorectal carcinoma underwent resection. In 20 cases, complete resection was achieved (median survival, 67 months). Incomplete resection and preoperatively elevated carcinoembryonic antigen (CEA) levels are independent risk factors for reduced survival. Patients developing pulmonary metastases prior to hepatic metastases had the worst prognosis. Surgical resection significantly increased survival compared to chemotherapy alone in matched-pair analysis (65 vs. 30 months, p = 0.03). CONCLUSIONS Incomplete resection and elevated CEA levels are predictors of poor outcome. Matched-paired analysis confirmed that surgical resection in combination with chemotherapy appears to be superior to chemotherapy alone.
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Affiliation(s)
- Georgios Meimarakis
- Department of General Thoracic Surgery, University of Munich-Grosshadern, Marchioninistrasse 15, Munich, Germany
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Blackmon SH, Stephens EH, Correa AM, Hofstetter W, Kim MP, Mehran RJ, Rice DC, Roth JA, Swisher SG, Walsh GL, Vaporciyan AA. Predictors of recurrent pulmonary metastases and survival after pulmonary metastasectomy for colorectal cancer. Ann Thorac Surg 2012; 94:1802-9. [PMID: 23063195 DOI: 10.1016/j.athoracsur.2012.07.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 06/21/2012] [Accepted: 07/03/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Resection of pulmonary colorectal carcinoma metastases may provide long-term benefit, but patient selection remains controversial. The objective of this study was to identify preoperative predictors of survival and lung recurrence for patients undergoing resection of such lesions. METHODS A prospectively collected database was retrospectively reviewed to identify patients who underwent their first colorectal carcinoma pulmonary metastasectomy. Two multivariate logistic analyses were performed to identify preoperative predictors of survival and lung recurrence. Preoperative factors, pathologic colorectal carcinoma stage, additional sites of metastases, timing of metastatic occurrence, and premetastasectomy disease-free interval were included in the univariate analyses. RESULTS From January 2000 to December 2010, 229 patients met inclusion criteria. The mean age was 60 years, and 100 patients (43.7%) were women. The overall median time and 5-year survival rate were 70.1 months and 55.4%, respectively, after the first pulmonary metastasectomy. Median follow-up was 37.2 months. Age older than 60 years (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.005 to 1.052; p=0.016), male sex (HR, 1.84; 95% CI, 1.089 to 3.094; p=0.023), and more than three lung metastases (HR, 1.15; 95% CI, 1.024 to 1.282; p=0.018) predicted survival at 5 years in one multivariate analysis. In the second, more than three lung metastases present at first metastasectomy (HR, 1.19; 95% CI, 1.071 to 1.321; p=0.001) and the preoperative disease-free interval of less than 3 years (HR, 0.99; 95% CI, 0.973 to 0.997; p=0.013) predicted lung recurrence. CONCLUSIONS Older age, male sex, and more lung metastases predict poorer survival after resection of pulmonary colorectal cancer metastases. The number of lung metastases present at the first metastasectomy and the preoperative disease-free interval predicted recurrence in the lung.
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Affiliation(s)
- Shanda H Blackmon
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, and Department of Surgery, The Methodist Hospital, Houston, Texas 77030, USA
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Pulmonary recurrence predominates after combined modality therapy for rectal cancer: an original retrospective study. Ann Surg 2012; 256:111-6. [PMID: 22664562 DOI: 10.1097/sla.0b013e31825b3a2b] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To characterize patterns of recurrence in locally advanced rectal cancer treated with combined modality therapy (CMT): neoadjuvant chemoradiation + total mesorectal excision + adjuvant chemotherapy. METHODS A total of 593 consecutive rectal cancer patients (1998 to 2007) with locally advanced (stage II/III) disease (noted on endorectal ultrasound or magnetic resonance imaging) who received CMT were analyzed for patterns of recurrence. RESULTS After median 44-month follow-up (interquartile range, 25 to 64 months), 119 patients (20%) recurred: 105 distant, 7 local, 7 local and distant, and 112 distant-only recurrence. Ninety-three (78%) had single-organ recurrence, and 26 (22%) had multiple-organ recurrence. The most common site of distant recurrence was lung (69% of all patients with distant relapse); 20% had liver recurrence. Fourteen patients (2.4%) recurred locally. Pulmonary metastases were most commonly identified by computed tomographic scan versus abnormal positron emission tomographic (PET) scan or carcinoembryonic antigen (CEA). Risk factors associated with pulmonary recurrence were the following: pathologic stage, tumor distance from anal verge, lymphovascular or perineural invasion. Five-year freedom from pulmonary recurrence for patients with 0, 1, 2, or 3 risk factors was 99%, 90%, 61%, and 42%, respectively. Thirty of 59 patents with pulmonary recurrence underwent lung metastasectomy; 3-year freedom from recurrence was 37%. CONCLUSIONS Unlike colon cancer, which most frequently recurs in the liver, locally advanced rectal cancer treated with CMT relapses most frequently in the lung. Pulmonary metastasis was associated with advanced pathologic stage, low-lying tumor, lymphovascular invasion, or perineural invasion. Confirmation of pulmonary metastasis usually requires serial imaging because metastases are often small when initially detected, well below the resolution of PET, and not necessarily associated with elevated CEA. Individualized risk-based surveillance strategies are recommended in this patient population.
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Nathan H, Bridges JF, Cosgrove DP, Diaz LA, Laheru DA, Herman JM, Schulick RD, Edil BH, Wolfgang CL, Choti MA, Pawlik TM. Treating patients with colon cancer liver metastasis: a nationwide analysis of therapeutic decision making. Ann Surg Oncol 2012; 19:3668-76. [PMID: 22875647 DOI: 10.1245/s10434-012-2564-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Criteria for resectability of colon cancer liver metastases (CLM) are evolving, yet little is known about how physicians choose a therapeutic strategy for potentially resectable CLM. METHODS Physicians completed a national Web-based survey that consisted of varied CLM conjoint tasks. Respondents chose among three treatment strategies: immediate liver resection (LR), preoperative chemotherapy followed by surgery (C → LR), or palliative chemotherapy (PC). Data were analyzed by multinomial logistic regression, yielding odds ratios (OR). RESULTS Of 219 respondents, 79 % practiced at academic centers and 63 % were in practice ≥10 years. Median number of cases evaluated was four per month. Surgical training varied: 51 % surgical oncology, 44 % hepato-pancreato-biliary/transplantation, 5 % no fellowship. Although each factor affected the choice of CLM therapy, the relative effect differed. Hilar lymph node disease predicted a strong aversion to LR with surgeons more likely to choose C → LR (OR 8.92) or PC (OR 49.9). Solitary lung metastasis also deterred choice of LR, with respondents favoring C → LR (OR 4.43) or PC (OR 6.97). After controlling for clinical factors, surgeons with more years in practice were more likely to choose PC over C → LR (OR 1.94) (P = 0.005). Surgical oncology-trained surgeons were more likely than hepatobiliary/transplant-trained surgeons to choose C → LR (OR 2.53) or PC (OR 4.15) (P < 0.001). CONCLUSIONS This is the first nationwide study to define the relative impact of key clinical factors on choice of therapy for CLM. Although clinical factors influence choice of therapy, surgical subspeciality and physician experience are also important determinants of care.
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Affiliation(s)
- Hari Nathan
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Factors influencing oncological outcomes in patients who develop pulmonary metastases after curative resection of colorectal cancer. Dis Colon Rectum 2012; 55:459-64. [PMID: 22426271 DOI: 10.1097/dcr.0b013e318246b08d] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognostic factors after pulmonary resection in patients with colorectal pulmonary metastases remain controversial. OBJECTIVE The study aimed to identify the predicting factors for oncological outcomes after curative resection in patients with colorectal cancer and pulmonary metastases. DESIGN This study is a retrospective review of prospectively collected data. SETTING This study was conducted at a tertiary care hospital/referral center in South Korea. PATIENTS Between January 2000 and June 2010, 105 patients who developed pulmonary metastases after curative resection for colorectal cancer were enrolled. Forty-eight patients underwent pulmonary resection, and the remaining 58 were given chemotherapy and/or best supportive care. MAIN OUTCOME MEASURES The primary outcomes measured were the predictive factors of survival and recurrence. RESULTS During the 35.9-month median follow-up period, 3- and 5-year overall survival rates were 54.6% and 30.4%. On multivariate analysis, absence of adjuvant chemotherapy after pulmonary metastases (p = 0.003), presence of extrapulmonary metastases (p = 0.001), elevated prelaparotomy serum CEA level (p = 0.015), and absence of pulmonary resection (p = 0.048) were independent prognostic factors for poor overall survival. In patients who underwent pulmonary resection, the 3-year pulmonary recurrence-free survival rate was 78.3%. On multivariate analysis, elevated prelaparotomy serum CEA level (p = 0.018) and disease-free interval ≤ 12 months (p = 0.008) were independent risk factors associated with pulmonary re-recurrence after pulmonary resection. LIMITATIONS This study took place at a single institution and had a small sample size. CONCLUSION Although we admit, to some degree, the benefits of the selection mechanism, pulmonary metastasectomy from colorectal cancer may improve survival after curative resection of colorectal cancer. Adjuvant chemotherapy, extrapulmonary metastases, and prelaparotomy CEA value are independent prognostic factors for overall survival. Prelaparotomy serum CEA level may be an especially reliable predictor of both overall survival and recurrence-free survival after pulmonary metastasectomy in patients who undergo curative resection for colorectal cancer.
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Tampellini M, Ottone A, Bellini E, Alabiso I, Baratelli C, Bitossi R, Brizzi MP, Ferrero A, Sperti E, Leone F, Miraglia S, Forti L, Bertona E, Ardissone F, Berruti A, Alabiso O, Aglietta M, Scagliotti GV. The role of lung metastasis resection in improving outcome of colorectal cancer patients: results from a large retrospective study. Oncologist 2012; 17:1430-8. [PMID: 22956535 PMCID: PMC3500365 DOI: 10.1634/theoncologist.2012-0142] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of surgery for lung metastases (LM) secondary to colorectal cancer (CRC) remains controversial. The bulk of evidence is derived from single surgical series, hampering any definitive conclusions. The aim of this study was to compare the outcomes of CRC patients with LM submitted to surgery with those who were not. PATIENTS AND METHODS Data from 409 patients with LM as the first evidence of advanced disease were extracted from a database of 1,411 patients. Patients were divided into three groups: G1, comprised of 155 patients with pulmonary and extrapulmonary metastases; G2, comprised of 104 patients with LM only and no surgery; G3, comprised of 50 patients with LM only and submitted to surgery. RESULTS No difference in response rates emerged between G1 and G2. Median progression-free survival (PFS) times were: 10.3 months, 10.5 months, and 26.2 months for G1, G2, and G3, respectively. No difference in PFS times was observed between G1 and G2, whereas there was a statistically significant difference between G2 and G3. Median overall survival times were 24.2 months, 31.5 months, and 72.4 months, respectively. Survival times were longer in resected patients: 17 survived >5 years and three survived >10 years. In patients with LM only and no surgery, four survived for 5 years and none survived >10 years. CONCLUSIONS Even though patients with resectable LM are more likely to be those with a better outcome, our study provides evidence suggesting an active role of surgery in improving survival outcomes in this patient subset.
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Affiliation(s)
- Marco Tampellini
- Oncology Unit, Department of Clinical and Biological Sciences, University of Torino, San Luigi di Orbassano, Italy.
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Yamauchi Y, Izumi Y, Kawamura M, Nakatsuka S, Yashiro H, Tsukada N, Inoue M, Asakura K, Nomori H. Percutaneous cryoablation of pulmonary metastases from colorectal cancer. PLoS One 2011; 6:e27086. [PMID: 22096520 PMCID: PMC3212539 DOI: 10.1371/journal.pone.0027086] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/10/2011] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of cryoablation for metastatic lung tumors from colorectal cancer. METHODS The procedures were performed on 24 patients (36-82 years of age, with a median age of 62; 17 male patients, 7 female patients) for 55 metastatic tumors in the lung, during 30 sessions. The procedural safety, local progression free interval, and overall survival were assessed by follow-up computed tomographic scanning performed every 3-4 months. RESULTS The major complications were pneumothorax, 19 sessions (63%), pleural effusion, 21 sessions (70%), transient and self-limiting hemoptysis, 13 sessions (43%) and tract seeding, 1 session (3%). The 1- and 3-year local progression free intervals were 90.8% and 59%, respectively. The 3-years local progression free intervals of tumors ≤15 mm in diameter was 79.8% and that of tumors >15 mm was 28.6% (p = 0.001; log-rank test). The 1- and 3-year overall survival rates were 91% and 59.6%, respectively. CONCLUSION The results indicated that percutaneous cryoablation is a feasible treatment option. The local progression free interval was satisfactory at least for tumors that were ≤15 mm in diameter.
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Affiliation(s)
- Yoshikane Yamauchi
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
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Kawano D, Takeo S, Tsukamoto S, Katsura M, Masuyama E, Nakaji Y. Prediction of the prognosis and surgical indications for pulmonary metastectomy from colorectal carcinoma in patients with combined hepatic metastases. Lung Cancer 2011; 75:209-12. [PMID: 21821306 DOI: 10.1016/j.lungcan.2011.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 07/08/2011] [Accepted: 07/13/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND The value of surgical treatment for patients with pulmonary and hepatic metastases from colorectal carcinoma is controversial. The purpose of this study was to analyze our initial experience with this aggressive strategy, and to define the prognosis and the surgical indications. METHODS The records of 35 patients who underwent surgical treatments for both hepatic and pulmonary metastases from colorectal carcinoma, from January 1997 to December 2008, were retrospectively analyzed. RESULTS There were 18 females and 17 males with a median age was 62.0 years. The primary colorectal neoplasm was located at the colon in 23 patients (65.7%) and in the rectum in 12 patients (34.3%). The overall 5-year and 10-year survival rates were 65.3% and 31.5% from the date of primary colorectal resection, respectively. For patients who underwent metachronous hepatic and pulmonary surgical treatment, the 10-year survival rate was 40.9%, which was significantly better than that of those undergoing synchronous hepatic and pulmonary surgical treatment (p=0.0265). Patients who have pulmonary less than ten of metastasis thus seemed to have a better prognosis than those with more than ten, but the difference was quite significant (p=0.0719). In a multivariate Cox proportional hazards model, synchronous hepatic and pulmonary metastases was identified as an independent predictor of adverse survival (p=0.0073). CONCLUSIONS The results of our study suggest that hepatic and pulmonary surgical treatment can provide a better prognosis for patients with metachronous hepatic and pulmonary metastases from colorectal carcinoma. We believe that aggressive metastasectomy can be an option for selected patients, even if a patient has been previously treated for hepatic and pulmonary metastases from colorectal carcinoma.
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Affiliation(s)
- Daigo Kawano
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, 1-8-1 Jigyo, Fukuoka 810-8563, Japan.
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Validation of a nomogram for predicting overall survival after resection of pulmonary metastases from colorectal cancer at a single center. World J Surg 2011; 34:2973-8. [PMID: 20703466 DOI: 10.1007/s00268-010-0745-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The goal of this study was to validate a survival nomogram at a single center, originally developed at multiple institutions in Japan, which combines readily available preoperative variables to predict overall survival after resection of pulmonary metastases from colorectal cancer. METHODS An external patient cohort from a prospective pulmonary metastases database at the Aichi Cancer Center in Japan was used to test the validity of the pulmonary metastases from a colorectal cancer nomogram. The cohort included 58 consecutive patients who had surgery between January 1999 and December 2005. Nomogram predictions for 3- and 5-year overall survival were calculated for each patient and compared with actual survival. The concordance index was used as an accuracy measure. RESULTS Data for all necessary variables were available for all patients. At the last follow-up, 30 patients were alive, with a median follow-up of 39 (range, 5-94) months. The 1-, 2-, 3-, and 5-year overall survival rates were 96.6, 84.5, 70.5, and 48.9%, respectively. The nomogram concordance index was 0.81 with excellent calibration for both 3- and 5-year overall survival rates. CONCLUSIONS The high predictive accuracy of pulmonary metastases from a colorectal cancer nomogram demonstrates that this predictive tool derived at multiple institutions can be applied to a small cohort of patients in a single center.
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Song KD, Chung MJ, Kim HC, Jeong SY, Lee KS. Usefulness of the CAD system for detecting pulmonary nodule in real clinical practice. Korean J Radiol 2011; 12:163-8. [PMID: 21430932 PMCID: PMC3052606 DOI: 10.3348/kjr.2011.12.2.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/12/2010] [Indexed: 11/15/2022] Open
Abstract
Objective We wanted to evaluate the usefulness of the computer-aided detection (CAD) system for detecting pulmonary nodules in real clinical practice by using the CT images. Materials and Methods Our Institutional Review Board approved our retrospective study with a waiver of informed consent. This study included 166 CT examinations that were performed for the evaluation of pulmonary metastasis in 166 patients with colorectal cancer. All the CT examinations were interpreted by radiologists and they were also evaluated by the CAD system. All the nodules detected by the CAD system were evaluated with regard to whether or not they were true nodules, and they were classified into micronodules (MN, diameter < 4 mm) and significant nodules (SN, 4 ≤ diameter ≤ 10 mm). The radiologic reports and CAD results were compared. Results The CAD system helped detect 426 nodules; 115 (27%) of the 426 nodules were classified as true nodules and 35 (30%) of the 115 nodules were SNs, and 83 (72%) of the 115 were not mentioned in the radiologists' reports and three (4%) of the 83 nodules were non-calcified SNs. One of three non-calcified SNs was confirmed as a metastatic nodule. According to the radiologists' reports, 60 true nodules were detected, and 28 of the 60 were not detected by the CAD system. Conclusion Although the CAD system missed many SNs that are detected by radiologists, it helps detect additional nodules that are missed by the radiologists in real clinical practice. Therefore, the CAD system can be useful to support a radiologist's detection performance.
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Affiliation(s)
- Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Bird N, Bird R, Majeed A. Effects of Surgery and Palliative Chemotherapy in the Treatment of Colorectal Liver Metastasis. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ss.2011.26066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Suemitsu R, Takeo S, Kusumoto E, Hamatake M, Ikejiri K, Saitsu H. Results of a pulmonary metastasectomy in patients with colorectal cancer. Surg Today 2010; 41:54-9. [DOI: 10.1007/s00595-009-4244-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 08/12/2009] [Indexed: 12/13/2022]
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Limmer S, Oevermann E, Killaitis C, Kujath P, Hoffmann M, Bruch HP. Sequential surgical resection of hepatic and pulmonary metastases from colorectal cancer. Langenbecks Arch Surg 2010; 395:1129-38. [PMID: 20165954 PMCID: PMC2974188 DOI: 10.1007/s00423-010-0595-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 01/13/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Resection of isolated hepatic or pulmonary metastases from colorectal cancer is widely accepted and associated with a 5-year survival rate of 25-40%. The value of aggressive surgical management in patients with both hepatic and pulmonary metastases still remains a controversial area. MATERIALS AND METHODS A retrospective review of 1,497 patients with colorectal carcinoma (CRC) was analysed. Of 73 patients identified with resection of CRC and, at some point in time, both liver and lung metastases, 17 patients underwent metastasectomy (resection group). The remaining 56 patients comprised the non-resection group. Primary tumour, hepatic and pulmonary metastases of all patients were surgically treated in our department of surgery, and the results are that of a single institution. RESULTS The resection group had a 3-year survival of 77%, a 5-year survival of 55% and a 10-year survival of 18%; median survival was 98 months. The longest overall survival was 136 months; six patients are still alive. In the resection group, overall survival was significantly higher than in the non-resection group (p < 0.01). Independent from the chronology of metastasectomy, 5-year survival was 55% with respect to the primary resection, 28% with respect to the first metastasectomy and 14% with respect to the second metastasectomy. A disease-free interval (>18 months), stage III (UICC) and age (<70 years) were found to be significant prognostic factors for overall survival. CONCLUSION Our report strongly supports aggressive surgical therapy in patients with both hepatic and pulmonary metastases from CRC. Overall survival for surgically treated selected patients with both hepatic and pulmonary metastases from CRC is comparable to hepatic or pulmonary metastasectomy. Simultaneous metastases tend to have a poorer outcome than metachronous metastases.
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Affiliation(s)
- Stefan Limmer
- Department of Surgery, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany.
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Abstract
Metastatic colorectal cancer traditionally has been considered incurable. Over the past 3 decades, however, resection of low-volume hepatic disease has been recognized as beneficial in some cases. More recently, resection of isolated pulmonary metastases has been shown to offer long-term survival in carefully selected patients. Resection of metastases to more unusual sites (ovary, brain, peritoneal cavity) is more controversial; nevertheless, retrospective data suggest that a few patients may be cured with resection of these tumors. In this article, we review the history and current status of metastasectomy in stage IV colorectal cancer.
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Affiliation(s)
- Najjia Mahmoud
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Landes U, Robert J, Perneger T, Mentha G, Ott V, Morel P, Gervaz P. Predicting survival after pulmonary metastasectomy for colorectal cancer: previous liver metastases matter. BMC Surg 2010; 10:17. [PMID: 20525275 PMCID: PMC2887792 DOI: 10.1186/1471-2482-10-17] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/03/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Few patients with lung metastases from colorectal cancer (CRC) are candidates for surgical therapy with a curative intent, and it is currently impossible to identify those who may benefit the most from thoracotomy. The aim of this study was to determine the impact of various parameters on survival after pulmonary metastasectomy for CRC. METHODS We performed a retrospective analysis of 40 consecutive patients (median age 63.5 [range 33-82] years) who underwent resection of pulmonary metastases from CRC in our institution from 1996 to 2009. RESULTS Median follow-up was 33 (range 4-139) months. Twenty-four (60%) patients did not have previous liver metastases before undergoing lung surgery. Median disease-free interval between primary colorectal tumor and development of lung metastases was 32.5 months. 3- and 5-year overall survival after thoracotomy was 70.1% and 43.4%, respectively. In multivariate analysis, the following parameters were correlated with tumor recurrence after thoracotomy; a history of previous liver metastases (HR = 3.8, 95%CI 1.4-9.8); and lung surgery other than wedge resection (HR = 3.0, 95%CI 1.1-7.8). Prior resection of liver metastases was also correlated with an increased risk of death (HR = 5.1, 95% CI 1.1-24.8, p = 0.04). Median survival after thoracotomy was 87 (range 34-139) months in the group of patients without liver metastases versus 40 (range 28-51) months in patients who had undergone prior hepatectomy (p = 0.09). CONCLUSION The main parameter associated with poor outcome after lung resection of CRC metastases is a history of liver metastases.
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Affiliation(s)
- Ulrich Landes
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - John Robert
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Thomas Perneger
- Department of Biostatistics, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Gilles Mentha
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Vincent Ott
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Philippe Morel
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
| | - Pascal Gervaz
- Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland
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Colon cancer. Crit Rev Oncol Hematol 2010; 74:106-33. [DOI: 10.1016/j.critrevonc.2010.01.010] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/30/2009] [Accepted: 01/06/2010] [Indexed: 12/15/2022] Open
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Fiorentino F, Hunt I, Teoh K, Treasure T, Utley M. Pulmonary metastasectomy in colorectal cancer: a systematic review and quantitative synthesis. J R Soc Med 2010; 103:60-6. [PMID: 20118336 DOI: 10.1258/jrsm.2009.090299] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Surgical removal of pulmonary metastases from colorectal cancer is undertaken increasingly but the practice is variable. There have been no randomized trials of effectiveness. We needed evidence from a systematic review to plan a randomized controlled trial. DESIGN A formal search for all studies concerning the practice of pulmonary metastasectomy was undertaken including all published articles using pre-specified keywords. Abstracts were screened, reviewed and data extracted by at least two of the authors. Information across studies was collated in a quantitative synthesis. RESULTS Of 101 articles identified, 51 contained sufficient quantitative information to be included in the synthesis. The reports were published between 1971 and 2007, and reported on 3504 patients. There was little change over time in patient characteristics such as age, sex, the time elapsed since resection of the primary cancer, its site or stage. The proportion with multiple metastases or elevated carcinoma embryonic antigen (CEA) did not change over time but there was an apparent increase in the proportion of patients who also had hepatic metastasectomy. Differences in 5-year survival between groups defined by CEA or by single versus multiple metastases persisted over time. Few data were available concerning postoperative morbidity, postoperative lung function or change in symptoms. CONCLUSION The quality of evidence available concerning pulmonary metastasectomy in colorectal cancer is not sufficient to draw inferences concerning the effectiveness of this surgery. There is great variety in what was reported and its utility. Given the burdensome nature of the surgery involved, better evidence, ideally in the form of a randomized trial, is required for the continuance of this practice.
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Affiliation(s)
- Francesca Fiorentino
- Clinical Operational Research Unit, Department of Mathematics, University College London London WC1H 0BT
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Strobel O, Hackert T, Hartwig W, Bergmann F, Hinz U, Wente MN, Fritz S, Schneider L, Büchler MW, Werner J. Survival data justifies resection for pancreatic metastases. Ann Surg Oncol 2009; 16:3340-9. [PMID: 19777190 DOI: 10.1245/s10434-009-0682-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pancreatic metastases are uncommon and little is known about the oncologic outcome after resection or prognostic parameters. This study was designed to evaluate perioperative and follow-up results after resection for pancreatic metastases and to define prognostic factors. METHODS From a prospective database, all consecutive resections performed at our institution for pancreatic metastases between October 2001 and July 2008 were identified. Clinicopathological details, perioperative, and follow-up results were analyzed. Uni- and multivariate analysis were performed to identify parameters associated with overall and disease-free survival. RESULTS Forty-four resections were performed for pancreatic metastases. Primary tumors included 31 (70%) renal cell carcinomas (RCC) and 13 other primary tumors. Morbidity was 33% and mortality 4.4%. Pancreatic metastases occurred after a median interval of 6.9 years after resection of the primary tumor. Twenty-five patients (57%) had additional extrapancreatic disease. With a median follow-up of 32.1 months, overall 3- and 5-year survivals were 70.2% and 56.8%, disease-free 3- and 5-year survivals were 37.2% and 33%, respectively. Patients with isolated pancreatic metastases had an overall 3- and 5-year survival of 85.6% and 74.9%. Additional extrapancreatic disease, a disease-free interval of less than 36 months, and non-RCC entity were associated with shorter overall survival. Previous recurrence, non-RCC primary tumors, and a disease-free interval of less than 36 months were associated with shorter disease-free survival. CONCLUSIONS Resection for pancreatic metastases can be performed safely and with good follow-up results and can be recommended as part of an interdisciplinary treatment. Especially in patients with isolated pancreatic metastases, long-term survival can be expected.
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Affiliation(s)
- Oliver Strobel
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
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